Kasna dijagnoza paraganglioma mokraćne bešike zbog neubedljivih adrenergičkih simptoma

  • Tamara Dragović Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Dejan Marinković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
  • Snežana Kuzmić-Janković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
  • Novak Milović Clinic for Urology, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Božidar Kovačević Institute of Pathology, Military Medical Academy, Belgrade, Serbia
  • Zoran Hajduković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/5773
Ključne reči: urinary bladder neoplasms||, ||mokraćna bešika, neoplazme, paraganglioma||, ||paragangliom, diagnosis||, ||dijagnoza, urologic surgical procedures||, ||hirurgija, urološka, procedure, histological techniques||, ||histološke tehnike,

Sažetak


Uvod. Paragangliom je redak neuroendokrini tumor koji vodi poreklo od ekstraadrenalnih autonomnih paraganglija. Paragangliom mokraćne bešike u tipičnom slučaju manifestuje se rekurentnim epizodama palpitacija, glavobolje i skokova krvnog pritiska, nastalih neposredno nakon mokrenja. Lečenje ovog tumora podrazumeva radikalni hirurški zahvat sa karakterističnom preoperativnom pripremom, antihipertenzivnom terapijom i dugotrajnim postoperativnim praćenjem. Prikaz bolesnika. Prikazali smo bolesnicu, staru 54 godine, sa funkcionalnim paragangliomom mokraćne besike i trogodišnjom evolucijom ponavljanih epizoda suprapubičnih bolova, praćenih hematurijom i dizuričnim smetnjama. Tokom prikupljanja detaljnijih anamnestičkih podataka, bolesnica je navela istovremeno prisustvo blagih adrenergičkih simptoma koji su nastupali neposredno nakon mokrenja, na koje inače ranije nije obraćala naročitu pažnju. Nakon sprovođenja dopunskih biohumoralnih i morfoloških ispitivanja dijagnostikovan je paragangliom mokraćne bešike. Tumorska masa je odstranjena parcijalnom cistektomijom, a imunohistohemijskom analizom potvrđeno je postojanje hromafinog tkiva. U radu su analizirane moguće kliničke prezentacije paraganglioma mokraćne besike, dijagnostički pristup i patohistološka analiza. Zaključak. S obzirom na to da bolesnici sa lokalizovanim paragangliomom imaju povoljnu prognozu, naglasili smo značaj pravovremeno uzete, tačne i detaljne anamneze kod bolesnika sa blagom, nerazjašnjenom, adrenergičkom simptomatologijom, koja je provocirana mokrenjem.

Reference

Kantorovich V, Pacak K. Pheochromocytoma and paragangli-oma. Prog Brain Res 2010; 182: 343−73.

Li W, Yang B, Che JP, Yan Y, Liu M, Li QY, et al. Diagnosis and treatment of extra-adrenal pheochromocytoma of urinary bladder: case report and literature review. Int J Clin Exp Med 2013; 6(9): 832−9.

Chrisoulidou A, Kaltsas G, Ilias I, Grossman AB. The diagnosis and management of malignant phaeochromocytoma and para-ganglioma. Endocr Relat Cancer 2007; 14(3): 569−85.

Beilan J, Lawton A, Hajdenberg J, Rosser C. Pheochromocytoma of the urinary bladder: A systemic review of the contemporary literature. BMC Urology 2013; 13(1): 22.

Disick GI, Palese MA. Extra-adrenal pheochromocytoma: Di-agnosis and management. Curr Urol Rep 2007; 8(1): 83−8.

Deng J, Li H, Zhang Y, Liu G. Functional paragangliomas of the urinary bladder: a report of 9 cases. Chin J Cancer 2010; 29(8): 729−34.

Li S, Lui S, Li F, Yue Q, Huang X, Gong Q. Unsuspected para-ganglioma of the urinary bladder with intraoperative hyperten-sive crises: A case report. Exp Ther Med 2013; 6(4): 1067−9.

Chen Y, Kuo HC. A small pheochromocytoma of the urinary bladder with atypical symptoms. Tzu Chi Med J 2006; 18: 295−8.

Xu D, Chen M, Liu Y, Gao Y, Cui X. Non-functional paragan-glioma of the urinary bladder: a case report. J Med Case Re-ports 2010; 4(1): 216.

Pichler R, Heidegger I, Klinglmair G, Kroiss A, Uprimny C, Gasser RW, et al. Unrecognized paraganglioma of the urinary bladder as a cause for basilar-type migraine. Urol Int 2014; 92(4): 482−7.

El Khoury F, Jour I, Malaeb B, Assaf G. Bladder paraganglioma. A case report. J Med Liban 2012; 60(3): 182−4.

Oderda M, Michelon F, Appendino M, Gallo M, Senetta R, Pacchioni D, et al. Primary bladder phaeochromocytoma diagnosed by a vet. Scand J Urol Nephrol 2010; 44(3): 186−9.

Tsai C, Wu W, Chueh K, Li W, Huang C, Wu C, et al. Paragan-glioma of the urinary bladder first presented by bladder bloody tamponade: two case reports and review of the literatures. Kaohsiung J Med Sci 2011; 27(3): 108−13.

Kang SG, Kang SH, Choi H, Ko YH, Park HS, Cheon J. Robot-assisted partial cystectomy of a bladder pheochromocytoma. Urol Int 2011; 87(2): 241−4.

Wu FM, Kao SL, Thamboo TP, Tsang WC, Heng CT, Tiong HY. Laparoscopic Partial Cystectomy for Symptomatic Paragangli-oma of the Urinary Bladder: A Case Report. Uro Today Int J 2011; 4(1): art3.

Zeitlin I, Dessau H, Lorberboym M, Beigel Y. Malignant pheo-chromocytoma of the urinary bladder: challenges in diagnosis and management. Isr Med Assoc J 2011; 13(5): 311−3.

Hanji AM, Rohan VS, Patel JJ, Tankshali RA. Pheochromocy-toma of the urinary bladder: a rare cause of severe hyperten-sion. Saudi J Kidney Dis Transpl 2012; 23(4): 813−6.

Manohar K, Mittal BR, Bhattacharya A, Kashyap R, Aggarwal MM, Mandal AK. A rare case of malignant urinary bladder paragan-glioma with distant metastases demonstrated by 18F-FDG PET/CT. Clin Nuc Med 2012; 37(6): 148−9.

Beilan J, Lawton A, Hajdenberg J, Rosser C. Locally advanced paraganglioma of the urinary baldder: a case report. BMC Res Notes 2013; 6: 156.

Macedo F, Filgueiras CH, de Abreu C, Carlos L, Reis AA, Neto RM, et al. Non-functionant urinary bladder paraganglioma. Health Med 2012; 6(2): 568−70.

Christodoulidou M, Lucky M, Mansour P, Gammal M. Incidental paraganglioma of the urinary bladder in a 66-year-old woman. BMJ Case Rep 2013; 2013. pii: bcr2013008771.

Acharya S, Shukla S, Gupta A, Mahajan SN. Extra Adrenal Phe-ochromocytoma Presenting as Hypertensive Crisis in a Young Male. Ind Med Gazette 2013: 238−41.

Ahn SG, Jang H, Han DS, Lee JU, Yuk SM. Transurethral re-section of bladder tumour (TURBT) as an optional treatment method on pheochromocytoma of the urinary bladder. Can Urol Assoc J 2013; 7(1−2): E130.

Feng N, Li X, Gao H, Liu Z, Shi L, Liu W. Urinary bladder ma-lignant paraganglioma with vertebral metastasis: a case report with literature review. Chin J Cancer 2013; 32(11): 624−8.

Malik AA, Afandi B, Jamil G, Akhter SM. Paraganglioma of urinary bladder. BMJ Case Rep 2013; 2013. pii: bcr2013010063.

Qian S, Yang L, Liu M, Li Y, Han P, Yuan J, et al. Bladder paraganglioma during pregnancy characterized by bladder bloody tamponade with normotension: A case report and re-view of the literatures. Health Med 2013; 7(5): 1388−91.

Han YJ, Shin HS, Jung YS, Rim H, Ock SY, Kim EJ. Bladder pheochromocytoma presented as thunderclap headache trig-gered by urination and angina pectoris. Kosin Med J 2013; 28(2): 161−5.

Kumar MU, Pande P, Savita SS, Ashwin PK, Yelikar BR. An Ex-tra-adrenal Pheochromocytoma Presenting as Malignant Hy-pertension-A Report of two cases. J Clin Diagn ResR 2013; 7(6): 1177−9.

Lai Y, Chen D, Yu Z, Ni L, Yang S. Non functioning paragan-glioma of the urinary bladder: A case report and review of the literature. Oncol Lett 2014; 7(3): 891−3.

Kempasiddaiah GM, Thimmaiah R, Gurappa M. A rare case of early pregnancy with paraganglioma of urinary bladder. Int J Cur Res Rev 2014; 6(4): 15−20.

Menon S, Goyal P, Suryawanshi P, Tongaonkar H, Joshi A, Bakshi G, et al. Paraganglioma of the urinary bladder: a clinicopathologic spectrum of a series of 14 cases emphasizing diagnostic dilemmas. Ind J Pathol Microbiol 2014; 57(1): 19−23.

Al-Zahrani AA. Recurrent urinary bladder paraganglyoma. Adv Urol 2010; 2010: 912125.

Eisenhofer G, Goldstein DS, Walther MM, Friberg P, Lenders JW, Keiser HR, et al. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab 2003; 88(6): 2656−66.

Lenders JW, Pacak K, Walther MM, Linehan W, Mannelli M, Friberg P, et al. Biochemical diagnosis of pheochromocytoma: which test is best. JAMA 2002; 287(11): 1427−34.

Brink I, Hoegerle S, Klisch J, Bley TA. Imaging of pheochromocy-toma and paraganglioma. Fam Cancer 2005; 4(1): 61−8.

Ilias I, Yu J, Carrasquillo JA, Chen CC, Eisenhofer G, Whatley M, et al. Superiority of 6-[18F]-fluorodopamine positron emission tomography versus [131I]-metaiodobenzylguanidine scintigra-phy in the localization of metastatic pheochromocytoma. J Clin Endocrinol Metab 2003; 88(9): 4083−7.

Liu Y, Dong S, Dong Z, Mao X, Shi X. Diagnosis and treatment of pheochromocytoma in urinary bladder. J Zhejiang Univ Sci B 2007; 8(6): 435−8.

Dilbaz B, Bayoglu Y, Oral S, Cavusoglu D, Uluoglu O, Dilbaz S. Laparoscopic resection of urinary bladder paraganglioma: a case report. Surg Laparosc Endosc Percutan Tech 2006; 16(1): 58−61.

Kliewer KE, Cochran AJ. A review of the histology, ultrastructure, immunohistology, and molecular biology of extra-adrenal paragangliomas. Arch Pathol Lab Med 1989; 113(11): 1209−18.

Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 9 (2015)
Rubrika
Prikaz bolesnika